Simulation Elective

NorthwesternSIMULATIONCENTER FOR EDUCATION IN MEDICINE

Immersion Programs:Post Graduate Elective inTechnology in Medical Education &Clinical Simulation

Northwestern SimulationNorthwestern University, Feinberg School of Medicine303 E Chicago Ave, WARD 18th FloorChicago, IL 60068T 312.503.7700 [email protected] simulation.northwestern.edu

CENTER FOR EDUCATION IN MEDICINE 2

Programs o!ered by Northwestern Simulation

Our goals are to:Provide a meaningful experience for post-graduate trainees seeking a career in the !eld of technology-enhanced medical education and clinical simulation. Learnerswill hone techniques relevant to not justsimulation,but to medical education more broadly.

This program will:Focus on advanced educational technologies and consist of several discreet immersion experiences in simulation and related !elds. Clinical service is not required. Trainees will learn via simulation in the area of their specialty.

Our objective is to expand the use of clinical simulation as a technique for education, outcomes research, and performance improvement to an international community.Why this program?

Simulation-based training focuses on improving human performance by creating opportunities for deliberate practice that increase the transfer of knowledge, skills, judgement, and attitudes to the clinical setting. The desire to use this strategy has led to rapid growth of medical and nursing simulation centers nationally. Educators at both academic and community medical centers may lack the necessary technical knowledge and skills to maximize the efficiency and use of simulation-based clinical education. This document outlines the development of an immersive program for post-graduates seeking a deeper knowledge of medical education, simulation, and educational technologies.

Target Audience

The audience for this program includes individuals in post-graduate medical training. Residents and fellows from any specialty training program are welcome.

Context: What is an immersion experience?

This program is designed for use by a variety of post-graduate trainees. Content will be presented over the course of four weeks. Five hours of didactic sessions are required per week with project assignments and practical experiences in medical education interspersed. On completion of the immersion program, learners may choose to complete a certificate in technology in medical education by submitting a process improvement project completed at their home institution.

Clinical service

Post-graduate trainees will not be permitted to provide patient care unless properly licensed and registered with the McGaw Medical Center, Northwestern University. There will be ample experience in simulated clinical care. Trainees will engage in specialty-apporpriate simulation-based training.

NORTHWESTERN SIMULATION 3

Learning Objectives

Define simulation and immersive learning and give examples of when these educational modalities are effective choices.

Describe adult learning principles and how those apply to simulation-based educational activities and mastery learning.

Synthesize learning events using instructional design principles and learning objectives based on subject matter.

Given a choice of available technologies and learning adjuncts, select the appropriate modalities to achieve learning objectives.

Apply principles of Advocacy-Inquiry to facilitate a post-simulation, debriefing session and support faculty.

Use software and hardware to capture instances of technical and non-technical behaviors for debriefing.

Understand the salient ethical and legal issues revolving around the capture and use of collected data in simulation-based events.

Demonstrate effective moulage techniques for enhancing realism.

Using knowledge of the existing modalities, produce immersive simulation environments to meet learning or assessment objectives.

The Goals of the Elective:

Learners will be able to demonstrate the use of simulation-based educational strategies including:needs and learner analysis;; creation of behavioral learning objectives;; scenario development and implementation;; moulage;; simulator innovations;; video-assisted debriefing;; and learner evaluation techniques.

The Didactic Program



About Our Faculty

The simulation program (STIL) formally resides within the Center for Education in Medicine, and is led by Dr. John Vozenilek, a member of the Feinberg Academy of Medical Educators and Associate Director of the Center for Education in Medicine. There are six core faculty of STIL.

Dr. Christine Park, MD, Medical Director of Clinical Simulation and the Patient Safety Simulation Center

Dr. Carla Pugh, MS, PhD, Medical Director of the Northwestern Center for Advanced Surgical Education (NCASE)

Dr. Mark Adler, MD, Chair of the Research Planning Committee and Director of KidSTAR

Susan Eller, RN MSN. Director for Interprofessional Education

Dr. Deb Rooney, PhD, Psychometrician

Dr. David Salzman, MD Simulation Instructor

STIL also supports a number of "Faculty Scholars" who complete projects with the center. There are greater than 20 faculty a"liates who frequently use the simulation center for education and for research.

Selected Bibliography1: Eppich W, Howard V, Vozenilek J, Curran I. Simulation-based team training in healthcare. Simul Healthc. 2011 Aug;6 Suppl:S14-9. PubMed PMID: 21817858.

2: Pugh CM. Warm-ups, Mental Rehearsals and Deliberate Practice: Adopting the Strategies of Elite Professionals. J Surg Res. 2011 Jun 25. [Epub ahead of print]PubMed PMID: 21816430.

3: Pugh CM. Medical Education Meets Patient Safety. J Surg Res. 2011 Jun 25. [Epub ahead of print] PubMed PMID: 21816429.

4: McGaghie WC, Draycott TJ, Dunn WF, Lopez CM, Stefani-dis D. Evaluating the impact of simulation on translational patient outcomes. Simul Healthc. 2011 Aug;6Suppl:S42-7. PubMed PMID: 21705966; PubMed Central PMCID: PMC3153601.

5: Kushner RF, Kessler S, McGaghie WC. Using behavior change plans to improve medical student self-care. Acad Med. 2011 Jul;86(7):901-6. PubMed PMID: 21617509;PubMed Central PMCID: PMC3128665.

6: Barsuk JH, Brake H, Caprio T, Barnard C, Anderson DY, Williams MV. Process changes to increase compliance with the universal protocol for bedside procedures. Arch Intern Med. 2011 May 23;171(10):947-9. PubMed PMID: 21606103.

7: Pugh CM, Bevan MG, Duve RJ, White HL, Magee JH, Wiehagen GB. A Retrospective Review of TATRC Funding for Medical Modeling and Simulation Technologies. SimulHealthc. 2011 Aug;6(4):218-25. PubMed PMID: 21546864.

8: McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic com-parative review of the evidence. Acad Med. 2011 Jun;86(6):706-11. Review. PubMed PMID: 21512370; PubMed Central PMCID: PMC3102783.

9: O'Leary KJ, Buck R, Fligiel HM, Haviley C, Slade ME, Landler MP, Kulkarni N, Hinami K, Lee J, Cohen SE, Williams MV, Wayne DB. Structured interdisciplinary rounds in a medical teaching unit: improving patient safety. Arch Intern Med. 2011 Apr 11;171(7):678-84. PMID: 21482844.


VR Space StorageRoom 1 Room 2 Room 3 Room 4 Room 5

Skills Lab

Conference

A B C

Dry LabOperating

Area (wet lab)

Lockers

Innovations

Computer

Reception

Reception

Control 1 Control 2

Kitchen

Corridor

hall

hall

hall

Storage

Storage / Prep

About Our Facility

STIL occupies a total of 12,000 square feet of space and is comprised of five patient rooms, two skill labs, a virtual reality training lab, and a large and small operating room. Outpatient encounters are experienced in the adjacent 12,000 square foot standardized patient Clinical Education Center. The space, when taken together, simulates a hospital environment using state-of-the-art devices, including adult and pediatric care delivery women’s health services, including childbirth, and training in emergency preparedness and emergency medical services. An executive conference board room and three debrief rooms are also included in the space. Every room has audio/visual recording and playback capabilities operated through a central control room, and wireless mics allow for audio to be captured as learners move from room to room.

Our innovations laboratory builds new training devices and tests medical devices using simulation. The McCormick School of Engineering partners with Feinberg in this effort.

STIL offers multi-faceted, interconnected service lines which represent the core resources within STIL. These include:

STIL Education: Undergraduate and Graduation Medical Education;;

Northwestern Center for Advanced Surgical Education (NCASE): for specialized surgical training and assessment;;

Northwestern SimulationTM: a revenue generating arm for continuing medical education and outside vendors;;

Media Lab: video and interactive web resources and durable learning objects;;

Innovations Lab: for the creation of new devices in partnership with faculty from the McCormick School of Engineering;;

Conferences: sponsorship of educational seminars for international audiences.



Details of the Curriculum

Lesson 1: Simulation Technology and Technology-based Adjuncts

Introduction: Everyone has heard the expression that practice makes perfect, in simulation-based learning the belief is that practice makes permanent. One of the responsibilities of simulation technicians is to help facilitate learning experiences that allow for the transfer of knowledge, skills, and attitudes into the clinical setting. Simulation provides the deliberate practice opportunities in a safe learning environment. There are many methods of delivering this type of education strategy.

Key Objective: Define simulation and immersive learning and give examples of when these training modalities are effective choices.

Enabling Objectives:1. Define simulation as an educational strategy and list four or five types of simulation devices.2. Describe two ways to prepare learners prior to start of simulation course or event.3. Give two examples of assessment technologies used during simulation.

Activities:1. Engage in a learning activity as a participant.2. Demonstrate use of task trainers, and high fidelity pediatric and adult simulators.


Lesson 2:Deliberate Practice, Adult Learning Principles, and Mastery Model

Introduction:Deliberate practice details the journey from novice to expert describing the type of focused, feedback-driven practice that is required. Simulation provides an environment in which learners can benefit from deliberate practice in a safe, controlled environment. These principles along with adult learning principles form the core of simulation as an educational tool.

Key Objective:Describe adult learning principles and how those apply to simulation-based educational activities and mastery learning.

Enabling Objectives:1. List key principles of adult learning theory and how those pertain to working professionals.2. Define deliberate practice and explain the components.3. Use Dreyfus or Brenner model to identify stages of learner development.4. Discuss core competencies of interprofessional education.

Activities:1. Apply mastery learning principles to a task-trainer-based experience.2. Evaluate two methods for standard setting in performance-based assessments.



Lesson 3:Instructional Design—a crash course

Introduction:A fundamental understanding of instructional design and learning objectives will help to both contextualize simulation-based curriculum as well as to assist faculty with basic instructional design. Learning events in the simulation lab that are effectively structured from an instructional design perspective lead to better educational outcomes.

Key Objective:Synthesize simulation-based training scenario(s) using instructional design principles and learning objectives.

Enabling Objectives:1. Perform needs analysis to determine if/what training is necessary.

2. Demonstrate an understanding of scenario design principles that are mannequin-independent.

3. Construct learning objectives with given condition, expected behavioral outcome, and evaluation criteria.

4. Design a scenario with a subject-matter expert guidance.

Activities:1. Create scenarios from learning objectives.

Lesson 1Lesson 2

Week 1 Week 2 Week 4Week 3

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Lesson 8Lesson 9

Lesson 1Lesson 2



Lesson 4:Fidelity in Simulation

Introduction:Simulation-based education allows for a flexible environment in which different levels of fidelity may be utilized. Enhanced fidelity can improve the educational outcomes for learners and faculty. However, using maximum fidelity at all times is not only unnecessary, but may be counterproductive. The simulation technician needs to be able to appropriately advise faculty on the level of fidelity that is most appropriate for their learning objectives.

Key Objective:Given a choice of available technologies and learning adjuncts, select the appropriate modalities to achieve learning objectives.

Enabling Objectives:1. Define the different types of fidelity in simulation.2. Choose level of equipment and environmental fidelity appropriate for a given scenario. (Discuss in-situ)

3. Differentiate between standardized patients and professional confederates;; and determine the best option for a scenario.

4. Describe the benefits and drawbacks of different levels of fidelity in simulation.

Activities:1. Given educational goals and scenario design learning events of varying fidelity.

Lesson 5:Debriefing Principles

Introduction:Much of the learning in simulation-based education comes not from the event itself, but from reflecting on that event in an organized debriefing. One method of debriefing is called Advocacy-Inquiry, which is designed to continue to provide a supportive, constructive learning environment that allows for debriefing with good judgment.

Key Objective:Apply principles of Advocacy-Inquiry to facilitate a post-simulation, debriefing session.

Enabling Objectives:1. List steps in the debriefing process: reaction, understanding, generalization.2. Demonstrate debriefing technique of Advocacy-Inquiry.3. Describe the importance of debriefing.

Activities:1. Engage in facilitated debriefing using Advocacy Inquiry in scenario-based environment


Lesson 6:AV In Simulation

Introduction:The role of AV in simulation is variable based on the objectives of a given event. AV is often used as a tool for video-assisted debriefing, but can also be used to capture data for research projects or allow people in remote locations to participate in simulation events.

Key Objective:Setup and utilize software and hardware to capture instances of technical and non-technical behaviors for debriefing.

Enabling Objectives:1. Describe the different uses for AV in simulation.2. Demonstrate the use of Studiocode to capture video performance.

3. Demonstrate the use of Coda to capture live data.4. Apply learned principles to setup a basic, in-situ video capture system.

Activities:1. Create a brief training video for a simulation technique2. Capture a recording of a task training session suitable for educational research

Lesson 7:Legal and Ethical Issues In Simulation

Introduction:Simulation-based education targets several audiences: students, residents, and practicing professionals. Performances are observed, evaluations are performed, and debriefings are done. Throughout the process, data is captured and much is learned about trainee performance and system issues. What is to be done with all of this data? What are our responsibilities with respect to this data? As the primary collectors and keepers of much of the data, simulation technicians need to understand the legal and ethical issues, implications, and ramifications of their work.

Key Objective:Understand the salient ethical and legal issues revolving around the capture and use of collected data in simulation-based events.

Enabling Objectives:1. Explain the legal issues surrounding the storage of video performance.2. Describe the ethical issues surrounding the performance of trainees in simulation.3. Generate a data storage policy.

Activities:1. Review and revise an AV storage and capture policy and workflow.



Lesson 8:Enhancing Realism Through Moulage and Innovation

Introduction:There are times when increased realism can be quite helpful to facilitate certain learning objectives. The quality and realism of simulation-based events can be greatly enhanced through the use of moulage. Additionally, other props or training devices can be created using several simple molding techniques.

Key Objective:Demonstrate effective moulage techniques for enhancing realism.

Enabling Objectives:1. Identify when enhanced realism can be useful.2. Understand how to use several molding techniques to create new objects.3. Demonstrate use of moulage to create trauma wounds.4. Demonstrate use of moulage to create changes in skin appearance.

Activities:1. Moulage a manikin or a standardized patient.

Lesson 9:Putting It All Together

Introduction:Performance as a simulation technician requires command of a variety of knowledge, skills, and attitudes. In this session, we bring all of these lessons together to create an effective learning environment.

Key Objective:Create an effective simulation session.

Enabling Objectives:Define threats to fidelity, efficacy, and to a safe learning environmentDemonstrate the use of best practices in simulation to enhance learning

Activities:Create and deploy an effective learning session using some form of simulation


About the Feinberg School of MedicineNorthwestern UniversityApproximately one of every five applicants to U.S. medical schools for the 2010-2011 academic year applied to the Feinberg School. The 170 members of the Class of 2014 include 89 men and 81 women who speak 24 different languages and have GPA averages of 3.79 overall and 3.74 in the sciences. This group ranked No. 12 in student selectivity, denoting outstanding matriculants to the MD Program. Historically known for recruiting outstanding students, Feinberg also enjoys a longstanding reputation for its undergraduate medical education curriculum, which we are currently in the process of renewing. Our objective is to transform ways of creating an innovative, integrated program that will provide students with earlier, substantive clinical experience, increased flexibility in designing a course of study, and the opportunity to explore scholarly areas of interest in greater depth.

Medical education is a lifelong process that requires the skills of self assessment, self reflection, continuous learning and professional accountability. These skills must be developed at the undergraduate medical level and continue on through residency and practice. We are committed to helping our students develop the skills that the modern physician needs to care for patients and be a leader in the practice of medicine. Our competency-based curriculum is based upon eight skills: patient-centered medical care;; effective communication and interpersonal skills;; medical scholarship and knowledge;; system awareness and team based care;; personal awareness and self care;; community engagement and service;; continuous learning and quality improvement;; and professional behavior and moral reasoning. The center for Simulation Technology and Immersive Learning is a vital resource in the execution of our training program.

Simulation Elective

Documents

clinical education

use of clinical simulation

postgraduate medical

nursing simulation centers

community medical centers

specialty training program

immersive program

clinical setting